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Comparing External Ventricular Drains-Related Ventriculitis Surveillance Definitions

  • Maria M. Reyes (a1), Satish Munigala (a1), Emily L. Church (a2), Tobias B. Kulik (a3), Salah G. Keyrouz (a3), Gregory J. Zipfel (a4) and David K. Warren (a1)...

Abstract

OBJECTIVE

To evaluate the agreement between the current National Healthcare Safety Network (NHSN) definition for ventriculitis and others found in the literature among patients with an external ventricular drain (EVD)

DESIGN

Retrospective cohort study from January 2009 to December 2014

SETTING

Neurology and neurosurgery intensive care unit of a large tertiary-care center

PATIENTS

Patients with an EVD were included. Patients with an infection prior to EVD placement or a permanent ventricular shunt were excluded.

METHODS

We reviewed the charts of patients with positive cerebrospinal fluid (CSF) cultures and/or abnormal CSF results while they had an EVD in place and applied various ventriculitis definitions.

RESULTS

We identified 48 patients with a total of 52 cases of ventriculitis (41 CSF culture-positive cases and 11 cases based on abnormal CSF test results) using the NHSN definition. The most common organisms causing ventriculitis were gram-positive commensals (79.2%); however, 45% showed growth of only 1 colony on 1 piece of media. Approximately 60% of the ventriculitis cases by the NHSN definition met the Honda criteria, approximately 56% met the Gozal criteria, and 23% met Citerio’s definition. Cases defined using Honda versus Gozal definitions had a moderate agreement (κ=0.528; P<.05) whereas comparisons of Honda versus Citerio definitions (κ=0.338; P<.05) and Citerio versus Gozal definitions (κ=0.384; P<.05) had only fair agreements.

CONCLUSIONS

The agreement between published ventriculostomy-associated infection (VAI) definitions in this cohort was moderate to fair. A VAI surveillance definition that better defines contaminants is needed for more homogenous application of surveillance definitions between institutions and better comparison of rates.

Infect Control Hosp Epidemiol 2017;38:574–579

Copyright

Corresponding author

Address correspondence to Maria Reyes, MD, 7777 Hennessy Blvd, Ste 7000, Baton Rouge, LA 70808 (Mariareyesa@gmail.com).

References

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1. Ramanan, M, Lipman, J, Shorr, A, Shankar, A. A meta-analysis of ventriculostomy-associated cerebrospinal fluid infections. BMC Infect Dis 2015;15:112.
2. Gutierrez-Gonzalez, R, Boto, GR, Perez-Zamarron, A. Cerebrospinal fluid diversion devices and infection. A comprehensive review. Eur J Clin Microbiol Infect Dis 2012;31:889897.
3. Lewis, A, Wahlster, S, Karinja, S, Czeisler, BM, Kimberly, WT, Lord, AS. Ventriculostomy-related infections: the performance of different definitions for diagnosing infection. Br J Neurosurg 2016;30:4956.
4. Schade, RP, Schinkel, J, Roelandse, FW, et al. Lack of value of routine analysis of cerebrospinal fluid for prediction and diagnosis of external drainage-related bacterial meningitis. J Neurosurg 2006;104:101108.
5. Lozier, AP, Sciacca, RR, Romagnoli, MF, Connolly, ES Jr. Ventriculostomy-related infections: a critical review of the literature. Neurosurgery 2002;51:170181.
6. CDC/NHSN surveillance definitions for specific types of infections. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/PDFs/pscManual/17pscNosInfDef_current.pdf. Published 2015. Accessed January 16, 2017.
7. Singh, N, Yu, VL. Rational empiric antibiotic prescription in the ICU. Chest 2000;117:14961499.
8. Honda, H, Jones, JC, Craighead, MC, Diringer, MN, Dacey, RG, Warren, DK. Reducing the incidence of intraventricular catheter-related ventriculitis in the neurology-neurosurgical intensive care unit at a tertiary care center in St Louis, Missouri: an 8-year follow-up study. Infect Control Hosp Epidemiol 2010;31:10781081.
9. Gozal, YM, Farley, CW, Hanseman, DJ, et al. Ventriculostomy-associated infection: a new, standardized reporting definition and institutional experience. Neurocrit Care 2014;21:147151.
10. Citerio, G, Signorini, L, Bronco, A, Vargiolu, A, Rota, M, Latronico, N. External ventricular and lumbar drain device infections in ICU patients: a prospective multicenter Italian study. Crit Care Med 2015;43:16301637.
11. Meddings, J, Reichert, H, McMahon, LF Jr. Challenges and proposed improvements for reviewing symptoms and catheter use to identify National Healthcare Safety Network catheter-associated urinary tract infections. Am J Infect Control 2014;42:S236S241.
12. Mermel, LA, Allon, M, Bouza, E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009;49:145.
13. Adherence to the Centers for Disease Control and Prevention’s (CDC’s) infection definitions and criteria is needed to ensure accuracy, completeness, and comparability of infection information. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/cms/cms-reporting.html. Published 2015. Accessed May 1, 2016.
14. Woeltje, KF, Lin, MY, Klompas, M, Wright, MO, Zuccotti, G, Trick, WE. Data requirements for electronic surveillance of healthcare-associated infections. Infect Control Hosp Epidemiol 2014;35:10831091.

Comparing External Ventricular Drains-Related Ventriculitis Surveillance Definitions

  • Maria M. Reyes (a1), Satish Munigala (a1), Emily L. Church (a2), Tobias B. Kulik (a3), Salah G. Keyrouz (a3), Gregory J. Zipfel (a4) and David K. Warren (a1)...

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